West Australian Sleddog Sports Association

Person 1
Name: *

Person 2
Name:

Child 1
Name:
DOB: (DD/MM/YYYY)

Child 2
Name:
DOB: (DD/MM/YYYY)

Child 3
Name:
DOB: (DD/MM/YYYY)

Main Details

Address: *
Suburb: *
State: *
Post Code: *

Phone Number: *
Mobile:
Email: *

Other Details

Type of Membership: Adult Single $40 Adult Double $60 Family $60 Pensioner Single $25 Pensioner Double $34 Under 18's $20 *

How did you find out about the club?:

What breed(s) of dog do you own?:

Do you give permission for photo's of you / your dogs to be used by WASSA / ASSA for promotional material / website? Yes No *

ASSA Number: (If a current member)

Payment method: DD Cash Cheque Money Order Other *

Would you like to make a donation to the club? $1 $2 $3 $4 $5 $10 $15 $20

Do you agree to the terms and conditions below?: *

Terms and Conditions:
I hereby apply for Membership of the Western Australian Sleddog Sports Association (Inc.) (This includes membership to ASSA). If admitted as Members(s), I/We agree to be bound by the Rules, Regulations and Code of Ethics of both the Western Australian Sleddog Sports Association (WASSA) and Australian Sleddog Sports Association (ASSA).

Enquiries: wassacommittee@yahoogroups.com